What is the difference between public and private health insurance?

Public health insurance (GKV) is the solidarity system: contributions are based on income, not age or health. Family members without income are covered for free. Private health insurance (PKV) calculates individual premiums based on age, health status, and chosen coverage. Each person needs their own contract. GKV offers standardized basic benefits, while PKV allows individual packages with often shorter waiting times and chief physician treatment.

At what salary can I switch to private insurance?

As an employee, you must exceed the annual earnings threshold (JAEG) to switch to PKV. In 2026, this is EUR 73,800 gross per year (EUR 6,150/month). Self-employed and civil servants can choose freely regardless of income. Important: the salary must permanently exceed the JAEG, not just temporarily.

How much is the public insurance contribution in 2026?

The general GKV contribution rate in 2026 remains 14.6% of gross income (up to the assessment ceiling of EUR 66,150/year). Additionally, each insurer charges an individual additional contribution averaging 1.7% in 2026. Employer and employee split both contributions equally. Long-term care insurance adds 3.4% base rate (childless persons over 23 pay a 0.6% surcharge).

Are children really covered for free in public insurance?

Yes, children can be covered for free through family insurance in the GKV as long as they have no income above the marginal employment threshold. This applies until age 18, or until 25 if in education or university. In PKV, each child needs their own contract — which can become expensive with multiple children.

Why do private insurance premiums rise so much with age?

PKV premiums rise for two reasons: medical utilization increases with age, and premium adjustments become necessary due to rising healthcare costs and medical advances. While PKV insurers build age provisions (Alterungsrueckstellungen), these often aren't sufficient to fully offset premium increases. On average, PKV premiums rise about 3% annually.

Can I join public insurance as a freelancer?

Yes, freelancers can voluntarily remain in or return to GKV if they meet the requirements. The minimum contribution is based on a fictional minimum assessment basis. However, self-employed pay the full contribution without an employer share. Whether GKV or PKV is cheaper depends on income, age, health, and family situation.

Can I switch back from private to public insurance?

Switching back from PKV to GKV is only possible under specific conditions: your income must fall below the JAEG (e.g., through part-time work or job change), or you become unemployed. After age 55, returning to GKV is virtually impossible — even with declining income. This age limit is legally enshrined with very few exceptions.

Why is private insurance so cheap for civil servants?

Civil servants receive Beihilfe from their employer: 50% of medical costs are covered (70% for married, 80% for children). PKV only needs to cover the remainder, resulting in significantly lower premiums. Since GKV doesn't account for Beihilfe and charges full contributions, PKV is almost always more economical for civil servants.

What happens to my private insurance if I become unemployed?

When receiving unemployment benefits (ALG-I), you typically become mandatory GKV-insured, with the employment agency paying contributions. The same applies for ALG-II (Buergergeld). Those who opt out of mandatory insurance can stay in PKV, with the agency paying a subsidy equal to the GKV contribution. After unemployment, you may be able to return to PKV.

Is a high deductible in private insurance worth it?

A higher deductible significantly reduces monthly PKV premiums: with EUR 1,200 deductible, you typically save 20-25% compared to no deductible. Whether it's worthwhile depends on your health. If you rarely visit the doctor, a high deductible can pay off. But in years with treatment needs, you pay more out of pocket. A middle option (EUR 300-600) often offers the best compromise.

GKV Additional Contribution 2026: Which Health Insurer Is Cheapest? | Health Insurance Comparison Calculator

What Is the GKV Additional Contribution?

In addition to the general contribution rate of 14.6 percent, each statutory health insurer charges an individual additional contribution. This additional contribution varies significantly between insurers and is adjusted annually. In 2026, the average is 1.7 percent, but the range extends from 0.7 to 3.28 percent. This means the total contribution rate can range from 15.3 to 17.88 percent depending on your insurer.

For an employee with EUR 55,000 gross annual salary, the difference between the cheapest and most expensive insurer amounts to about EUR 60 monthly — or over EUR 700 per year. This is a substantial amount that motivates many insured persons to switch. For top earners at the assessment ceiling, the difference can even exceed EUR 100 per month.

The Cheapest Health Insurers in 2026

Particularly affordable insurers are often company health insurance funds (BKKs) and smaller guild insurance funds (IKKs). Some nationally available insurers with low additional contributions still offer a good range of services. Note: the lowest contribution doesn't automatically mean the best coverage.

When choosing an insurer, compare not just contributions but also additional benefits: professional dental cleaning, osteopathy, extended preventive care and digital services can make the difference. Some more expensive insurers offer benefits that pay off depending on your situation. An insurer that costs 0.3 percent more but covers EUR 200 annually for dental cleaning and EUR 150 for osteopathy may actually be cheaper overall.

How to Switch Health Insurers

Switching insurers is simple and free. You have a special cancellation right with every contribution adjustment and can switch with two months' notice at the end of the month. The new insurer handles the entire switching process and cancels your old membership.

Important: all GKV insurers offer the same statutory mandatory benefits. Differences exist only in additional services and customer service. A switch therefore means no loss of basic coverage. However, you should check whether ongoing treatments or approved medical aids are seamlessly transferred. Bonus programs and premium payments are typically lost when switching.

The process in detail: register with your new health insurer, which then handles the cancellation with your old insurer. Also inform your employer about the switch. The entire process typically takes two to three months and is completely unbureaucratic.

Contribution Development in Recent Years

The average additional contribution has risen continuously in recent years: from 0.9 percent in 2019 through 1.3 percent in 2023 to 1.7 percent in 2026. This development reflects rising healthcare costs, demographic change and increasing utilization of medical services.

Experts expect the additional contribution to continue rising in coming years — possibly to 2.0 to 2.5 percent by 2030. More pessimistic forecasts even suggest 3 percent if no structural reforms are implemented. This makes comparing insurers all the more important: even small differences add up to substantial amounts over the years.

Particularly dramatic were the increases in 2024 and 2025: many insurers raised their additional contributions by 0.3 to 0.8 percentage points — a historically high jump that prompted millions of insured persons to switch.

Tips for the Optimal Insurer Switch

Don't just check the current additional contribution — also look at the history: insurers that have kept their rates stable in recent years are often more reliable than those that have just lowered rates and may raise them again soon. Read reviews about customer service and check which additional benefits are relevant for your personal situation.

Additional Contribution and the PKV Decision

The rising additional contribution also influences the GKV-PKV decision: the higher the total GKV contribution, the more attractive PKV appears for high earners. However, you shouldn't view the additional contribution in isolation. The long-term development of PKV premiums (averaging 3 percent annually) far exceeds GKV increases. An additional contribution increase of 0.3 percent means perhaps EUR 8 per month for an average earner — while a PKV premium increase of 3 percent can be EUR 15 to 20 or more.

Our GKV-PKV calculator accounts for the projected increase in additional contributions in its long-term projection and shows you the realistic overall picture over 30 years. This way you can make an informed decision about whether switching to PKV makes sense despite rising GKV contributions.